Prescribe Morning-After Pill to Teens in Advance?

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Nov. 26, 2012 -- Pediatricians should routinely talk to their teen patients about emergency birth control and write them prescriptions for “morning-after pills” so they can get them quickly if necessary, according to a new policy statement from the American Academy of Pediatrics.

Although the U.S. teen pregnancy rate has declined over the last two decades, it is still higher than that of other industrialized nations, the academy’s adolescent medicine committee writes in the journal Pediatrics. About 80% of those pregnancies are unintended, resulting from the lack or failure of birth control such as condoms, the pediatricians write.

Morning-after pills can reduce the risk of pregnancy if used within 120 hours of intercourse, but they’re most effective if used within the first 24 hours. They work by preventing ovulation so that the ovaries don’t release eggs.

“Studies have shown that adolescents are more likely to use emergency contraception if it has been prescribed in advance of need,” the pediatricians write. “However, a majority of practicing pediatricians and pediatric residents do not routinely counsel patients about emergency contraception and have not prescribed it.”

The emergency birth control, sold as Plan B, Plan B One-Step, Next Choice, or Next Choice One Dose, is available without a prescription, but federal policy prevents the over-the-counter sale of the birth control to girls under 17. Girls 16 and younger need a prescription.

Talking About It

“It’s clear that the education around emergency contraception is lacking,” says Cora Breuner, MD, MPH, one of the policy statement’s authors.

Pediatricians “don’t want to bring up uncomfortable topics,” says Breuner, a professor in the adolescent medicine section at Seattle Children’s Hospital and the University of Washington. But, she says, it should be part of the routine conversation pediatricians have with their teen patients, along with telling them not to smoke or get into a car with someone who’s been drinking alcohol.

“Pediatricians who talk with adolescents about emergency contraception are providing much-needed medical advice,” says James Trussell, PhD, a faculty associate in the Office of Population Research at Princeton. In the mid-1990s, Trussell founded "The Emergency Contraception Web Site" and a toll-free hotline (888-NOT-2-LATE) to increase women’s knowledge about, and access to, emergency birth control. “Providing prescriptions in advance is even better medicine.”

Although multiple studies have shown that morning-after pills don’t increase risky sexual behavior or disrupt an established pregnancy, some doctors' personal values lead them to refuse to prescribe emergency birth control to teens, Breuner and her colleagues write.

Another American Academy of Pediatrics policy opinion states that such doctors have a duty to inform their patients about “relevant, legally available” options and refer them to doctors who will discuss and provide emergency contraception.

'Violation of Conscience'?

Steven Mosher, president of the Population Research Institute, based in Front Royal, Va., says he disagrees with that policy. “We reject this statement as a violation of conscience,” says Mosher, whose anti-abortion organization states that one of its goals is to "expose the myth of overpopulation."

Encouraging pediatricians to advocate for making emergency contraception available without a prescription to girls under 17, as the new policy statement does, “is a violation of parents’ rights and is also not in the best interest of the teenagers themselves,” Mosher says.

Elise Berlan, MD, MPH, an adolescent medicine specialist at Nationwide Children’s Hospital and the Ohio State University, says she’s rarely encountered a doctor whose personal beliefs prohibited discussion of emergency contraception. However, Berlan says, there’s been little research into why pediatricians do or don’t talk about sexual activity and birth control with their teen patients.

Some doctors might be concerned about being able to keep the conversation confidential, Berlan says. The federal HIPAA privacy rule protects confidential discussions between doctors and teen patients if their parents agree to leave the room, she says.

SOURCES:Cora Breuner, MD, MPH, professor in the medicine section at Seattle Children’s Hospital and the University of Washington.James Trussell, PhD, faculty associate in the Office of Population Research at Princeton.Steven Mosher, MA, MS, president of the Population Research Institute in Front Royal, Va.Elise Berlan, MD, MPH, adolescent medicine specialist at Nationwide Children’s Hospital and The Ohio State University.